Ankylosing Spondylitis & Reiter's Syndrome

Question 1

Describe Ankylosing Spondylitis

Answer 1

• Chronic inflammatory disease
• Unknown etiology-idiopathic
• Mostly involves axial skeleton
• 1970’s was acknowledged as a separate disease than RA
• More common in white population
• Males affected 2-3x more than women
• onset 15-30 years old
• 7.3 per 100,000 people

Question 2

What are associated symptoms of ankylosing spondylitis?

Answer 2

1. Eye disease – iridocyclitis in 25-30% of patients
2. Neuro complications from fractures, instability, compression or inflammation
3. At greater risk for fractures (C5-C6-C7 most common sites)
4. Atlantoaxial joint subluxation, atlanto-occipital subluxation
5. Increased kyphosis and lumbar flexion

Question 3

What is the diagnostic criteria for ankylosing spondylitis

Answer 3

1. Radiographic evidence of sacrolitis
2. Limitation of the lumbar spine
3. Limitation of chest expansion
4. Low back pain of more than 3 months duration—not relieved by rest and improved by exercise
5. Family history
   - May also have systemic issues

Question 4

What is the treatment for ankylosing spondylitis?

Answer 4

1. Exercises are the mainstay of Interventions
2. Extension promoting exercises (LOW IMPACT)
   - Swimming, etc
3. NSAIDS
4. Good functional prognosis
   PT helping manage sypmtoms

Question 5

Describe Reiter’s Syndrome

Answer 5

• reactive arthritis (can happen after GI problems)

- sterile inflammatory arthropathy distant in time and place from the initial initiating infective process

Question 6

What are the most common microbial pathogens that cause Reiter’s Syndrome?

Answer 6

1. shigella
2. salmonella
3. yersina
4. camphlobacter
5. Chlamydia

Question 7

What is the incidence rate of Reiter’s Syndrome?

Answer 7

1. usually follows vereneal disease or bacillary dysentery
2. occurs in 3rd decade of life
3. males more than females (5:1)

Question 8

What are the first half of S/S of Reiter’s Syndrome?

Answer 8

1. 1 to 3 weeks post urethritis or diarrhea
2. Joint stiffness
3. Myalgia
4. Restricted motion
5. Limited swelling
6. Low back pain (worse with bedrest/inactivity)**
7. Asymmetric pattern of knee, ankle, foot involvement**
8. Inflammation at tendinous insertion into bone rather than synovium
9. “sausage” digits

Question 9

What are the second half of S/S of Reiter’s Syndrome?

Answer 9

10. Severe and chronic disease: the spine is involved
11. Urogenital and gastrointestinal involvement
12. Muscous membrane and skin involvement (small shallow ulcers)
13. Eye involvement with conjunctivitis
14. Increased incidence in the HIV positive population
15. For most patients, severe phase lasts for several weeks to 6 months
16. In 15-30% of the patients, chronic arthritis develops over the next 10-20 years
17. Severity related to infective agent

Question 10

What is the treatment for Reiter’s Syndrome?

Answer 10

1. NSAIDs
2. Antibiotics with initial infection
3. Methotrexate (also used in RA) in severe cases
4. joint protection
5. functional activities
   Typically resolves but chronic arthritis can develop